Causes of Liver and Biliary dysfunction 

1. Obstruction 

Obstruction affects the flow of bile from the liver to the intestine, leading to cholestasis and liver dysfunction. 

Causes: 

Gallstones (cholelithiasis / choledocholithiasis) → stones in the common bile duct block bile flow. 
Tumours / malignancy → pancreatic cancer, cholangiocarcinoma, hepatocellular carcinoma compress bile ducts. 
Strictures / fibrosis → post-surgical, chronic inflammation. 
Parasites → e.g., Clonorchis sinensis (liver fluke). 

Clinical features: 

Jaundice (yellowing of skin/eyes) 
Dark urine, pale stools 
Pruritus (itching due to bile salts) 
Right upper quadrant (RUQ) pain 

2. Inflammation 

Inflammation of the liver or bile ducts can impair liver function. 

Causes: 

Hepatitis → viral (A, B, C, D, E), autoimmune, drug-induced. 
Cholangitis → inflammation of the bile ducts, often due to bacterial infection secondary to obstruction. 
Non-alcoholic fatty liver disease (NAFLD) → can progress to non-alcoholic steatohepatitis (NASH). 

Clinical features: 

Fatigue, malaise 
Mild jaundice 
Hepatomegaly (enlarged liver) 
Elevated liver enzymes (ALT, AST, ALP) 

3. Infection 

Infections can directly damage the liver or biliary system. 

Causes: 

Viral → hepatitis viruses (A–E), CMV, EBV. 
Bacterial → ascending cholangitis from obstruction (common bile duct infection). 
Parasitic → liver flukes (Fasciola hepatica, Clonorchis sinensis). 
Fungal → rare, e.g., Candida in immunocompromised patients. 

Clinical features: 
Fever, chills (especially in cholangitis) 
RUQ pain 
Jaundice 
Sepsis in severe cases 
 
4. Perforation / Bile Leak 

Rare but serious causes of liver or biliary dysfunction. 

Causes: 
Trauma (blunt abdominal trauma, surgery) 
Gallbladder perforation (complication of acute cholecystitis) 
Biliary tract injury during surgery (e.g., cholecystectomy) 

Clinical features: 
Severe abdominal pain 
Signs of peritonitis (rigid abdomen, rebound tenderness) 
Fever, sepsis 
Free fluid or air on imaging 

5. Cirrhosis 

Cirrhosis is the end-stage of chronic liver damage, leading to liver dysfunction and portal hypertension. 

Causes: 

Chronic alcohol use → alcoholic cirrhosis 
Chronic viral hepatitis B and C 
Non-alcoholic steatohepatitis (NASH) 
Autoimmune hepatitis 
Genetic/metabolic disorders → Wilson’s disease, hemochromatosis, alpha-1 antitrypsin deficiency 
Biliary causes → primary biliary cholangitis, primary sclerosing cholangitis 

Clinical features: 

Fatigue, weakness 
Jaundice 
Ascites (fluid in abdomen) 
Spider nevi, palmar erythema 
Easy bruising/bleeding 
Hepatic encephalopathy (confusion, asterixis) 

Lab findings: 

Elevated bilirubin, ALP, AST, ALT 
Low albumin 
Coagulopathy (prolonged PT/INR) 

Summary Table: Causes and Key Features 


 
Key Points  

Liver dysfunction often presents subtly; early signs include fatigue, anorexia, and mild jaundice. 
Jaundice is common to most biliary and liver pathologies but pattern (direct vs indirect bilirubin) can help identify obstructive vs hepatocellular causes. 
Labs: AST, ALT → hepatocellular injury; ALP, GGT → cholestasis; bilirubin → jaundice; INR/albumin → liver synthetic function. 
Imaging (US, CT, MRI) is essential for detecting obstruction, masses, or perforation. 
Prompt recognition of infection or perforation is critical because they can become life-threatening.